9.2 - Diabetic foot: management of wounds and considerations in biomechanics and amputations

Abstract

Current understanding and management of lower extremity wounds has evolved significantly over time. The application of these practices has precipitated better utilization of treatments, reduction in recidivism, and a greater appreciation of the complex foot and ankle wound environment. The most common causes of complex lower extremity wounds includes infection, ischemia, and deformity or some combination thereof. Considerations and strategies aimed at the treatment and suppression of complex wounds should aim to assess and address these factors on their myriad of levels with ultimate progression to a closed and balanced soft-tissue envelope. The complex lower extremity wound is undeniably disadvantaged due to an assortment of potential local and systemic factors that may hinder wound healing. With this in mind, it is imperative that clinicians be vigilant and attentive to this dynamic patient population, modify wound healing strategies appropriately, and engage in aggressive treatment practices. In this chapter we review the principles in the management of non-healing wounds and amputations of the foot and ankle and offer an assortment of considerations and strategies aimed at their treatment and suppression with special attention to the biomechanical implications, considerations, and available treatments strategies.